Environmental Stress and Biobehavioral Antecedents of Coronary Heart Disease

This article provides an overview of research on the biobehavioral antecedents of coronary heart disease. Attention is given first to evidence that stressful occupational settings characterized by high demands and low levels of control over the job are associated with increased coronary risk. Also discussed is a promising animal primate model of social stress and coronary atherosclerosis. Next, the current status of the Type A behavior pattern is reviewed, with recent evidence suggesting that Type A may not be a potent risk factor in all populations. However, specific Type A components such as hostility as well as mode of anger expression (anger-in) have been related to coronary disease in recent studies. Next discussed is research on physiologic responsiveness (reactivity) to emotional stress, which is being studied as a marker of processes involved in the development of cardiovascular disease. Stress, Type A components, and psychophysiologic reactivity are promising candidates for research on clinical intervention. However, further evidence is needed before stress and reactivity can be regarded as proven risk factors for coronary disease.